Podiatry Coding & Billing Alert

Hint: Don’t miss the risk-adjusted functional status change residual score deletion in 2020.

The Centers for Medicare & Medicaid Services (CMS) recently published the 2020 HCPCS Level II code changes. These updates will become effective on Jan. 1, 2020.

Although you’ll see very few updates for podiatry, you still need to highlight these changes. Read on to learn more about how the new revisions, additions, and deletions, as well as the new modifiers will impact your podiatry practice.

Focus on These 2 Brand-New Codes

The 2020 HCPCS Level II updates for podiatry will add more specificity, according to Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

You’ll see two new 2020 HCPCS Level II codes in 2020.

Code C1734: First, you will gain C1734 (Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable)).

While there is a HCPCS code, C1713 (Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)) to represent an anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)), the new HCPCS code C1734 for orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to-bone (implantable) gives the coder another choice that covers device/products that may be new to the market and that are not considered an anchor/screw, says Machelle Morningstar, CPC, COC, CEMC, COSC, AHIMA-approved ICD-10-CM/PCS trainer and owner/consultant at Morningstar Coding and Reimbursement Consultants in Charleston, South Carolina.

“I think C1734 will become widely used when coders are making the HCPCS choice for medical device surgeries, now, and in the future,” Morningstar says.

“Code C1734 may allow for billing of implantable materials such as bone plates or tendon anchors, which have always been part of the procedure,” Beresh adds.

Code L2006: You will also gain new code L2006 (Knee ankle foot device, any material, single or double upright, swing and/or stance phase microprocessor control with adjustability, includes all components (e.g., sensors, batteries, charger), any type activation, with or without ankle joint(s), custom fabricated).

“I like new HPCPS code L2006, as it describes some of the newer products on the market much more adequately than some of the established and relative HCPCS codes,” Morningstar says.

Tune Into 1 Deletion and 1 Revision

You’ll also see just one HCPCS Level II deletion and just one revision for podiatry in 2020.

Deletion: HCPCS Level II will delete G8657 (Risk-adjusted functional status change residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate).

Revision: You will also see one HCPCS Level II code revision for podiatry.

Revised from: G9731 (Patient unable to complete the foot/ankle fs prom at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available)

Revised to: G9731 (Patient unable to complete the ankle/foot fs prom at initial evaluation and/or discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available)

As you can see, this revision merely clarifies when the patient is unable to complete his foot/ankle fs prom. In 2020, it will be “at initial evaluation and/or discharge.” The reasons that patient is unable to complete the foot/ankle fs prom haven’t changed. They are still due to “blindness, illiteracy, severe mental incapacity, or language incompatibility.”

Also, remember that an adequate proxy must not be available.

Observe New Modifier Options and 1 Deletion

You’ll see eight new HCPCS Level II modifiers in 2020. They are as follows:

• MA (Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition)
• MB (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access)
• MC (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues)
• MD (Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances)
• ME (The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional)
• MF (The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional)
• MG (The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional)
•  MH (Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider)

Deletion: You will lose modifier GD (Units of service exceeds medically unlikely edit value and represents reasonable and necessary services) in 2020.